Risk for posterior capsule rupture after vitreoretinal surgery.
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Biomedical subjects
Riaz H Y Asaria
Publications and source records attributed to Riaz H Y Asaria.
A randomized controlled trial of combined 5-fluorouracil and low-molecular-weight heparin in management of established proliferative vitreoretinopathy.
OBJECTIVE: To determine the efficacy of a combination of 5-fluorouracil and low-molecular-weight heparin (LMWH) to improve the outcome of surgery for established proliferative vitreoretinopathy (PVR). DESIGN: Double-masked, prospective, randomized, placebo-controlled clinical trial. SETTING: Three tertiary-referral teaching hospital vitreoretinal surgical units. PATIENTS: One hundred fifty-seven patients with established PVR (grade C, anterior or posterior) undergoing vitrectomy surgery. INTERVENTION: All patients underwent vitreoretinal surgery and silicone oil exchange with or without membrane peeling and/or retinectomy. Patients were randomly allocated to perioperative infusion with or without 5-fluorouracil (200 microg/ml) and LMWH (5 IU/ml) in Hartmann's solution for 1 hour. OUTCOME MEASURES: The primary outcome measure was defined as posterior retinal reattachment after removal of silicone oil without any reoperations at 6 months. Secondary outcome measures recorded were posterior retinal reattachment, localized/tractional retinal detachment, visual acuity, macular pucker, hypotony, glaucoma, keratopathy, and cataract. Removal of silicone oil and reoperations were also recorded. RESULTS: Overall, at 6 months 84% of patients had full retinal reattachment and 94% had stable posterior retinal reattachment. There was no significant difference in success in the primary outcome measure (56%, treatment group; 51%, placebo group; P = 0.59) or in secondary outcome measures or rates of complications. Secondary macular pucker occurred less often in the treatment group (6% vs. 17% at 6 months, P = 0.068). CONCLUSIONS: A perioperative infusion of combined 5-fluorouracil and LMWH does not significantly increase the success rate of vitreoretinal surgery for established PVR.
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Proliferative vitreoretinopathy: developments in pathogenesis and treatment.
Proliferative vitreoretinopathy is an abnormal wound-healing response following retinal detachment and occurs in 5% to 10% of cases. It is now possible to treat this once-blinding condition. However, proliferative vitreoretinopathy still remains the most common cause of failure to reattach the retina. Recent work has helped to unravel the causes of proliferative vitreoretinopathy, and new adjuvant treatments are being evaluated to improve the success rate of retinal reattachment surgery, both anatomically and functionally. At present, preventative treatment has only been found to work in high-risk cases. It is hoped that improvement in targeted immunosupression will eventually reduce the incidence of proliferative vitreoretinopathy. At the current time, the management of proliferative vitreoretinopathy still remains a surgical skill.
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